Drug therapy fails veterans

Study shows powerful mood-altering medicine ineffective in PTSD cases

By BENEDICT CAREY New York Times

Published 12:00 am, Wednesday, August 3, 2011

Drugs widely prescribed to treat severe post-traumatic stress symptoms for veterans are no more effective than placebos and come with serious side effects, including weight gain and fatigue, researchers reported on Tuesday.

The surprising finding, from the largest study of its kind in veterans, challenges current treatment standards so directly that it could alter practice soon among doctors treating returning military personnel, some experts said.

Ten percent to 20 percent of those who see heavy combat develop lasting symptoms of post-traumatic stress disorder, and about a fifth of those who get treatment receive a prescription for a so-called antipsychotic medication, according to government numbers.

The new study, published in the Journal of the American Medical Association, focused on one such medication, Risperdal. But experts said that its results most likely extend to the entire class, including drugs like Seroquel, Geodon and Abilify.

"I think it's a very important study," given how frequently the drugs have been prescribed, said Dr. Charles Hoge, a senior scientist at the Walter Reed Army Institute of Research, who was not involved in the study but wrote an editorial accompanying it. He added, "It's very rigorously done, and it definitely calls into question the use of antipsychotics in general for PTSD."

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The use of antipsychotics, which strongly affect mood, has grown sharply over the past decade, as thousands of returning soldiers and Marines have found that their PTSD symptoms do not respond to antidepressants, the only drugs backed by scientific evidence.

Researchers affiliated with the Veterans Affairs medical system had 123 veterans with PTSD begin a regimen that added Risperdal to their treatment. Some had served in Vietnam, others in Iraq or Afghanistan; all had tried antidepressants and found little relief. After six months, they were doing no better than a similar group of 124 veterans who were given placebo pills. About 5 percent in both groups recovered, and 10 percent to 20 percent reported at least some improvement, based on standardized measures of severity.